Neuroendocrine carcinoma of the larynx with Lambert-Eaton myasthenic syndrome: a rare case report and literature review

Abstract

This current report describes a rare clinical case of neuroendocrine carcinoma (NEC) of the larynx with associated Lambert-Eaton myasthenic paraneoplastic syndrome (LEMS). A 68-year-old male patient presented with severe dysphonia and dysphagia. He underwent a total laryngectomy and the excised lesion was extremely large. A pathological examination demonstrated ‘morphological findings of a poorly differentiated carcinoma (G3) with aspects of neuroendocrine differentiation’ (i.e. a poorly differentiated neuroendocrine carcinomas [PD-NEC]). Based on the patient’s medical history and the immunohistochemical findings, he was treated with three cycles of neoadjuvant chemotherapy (cisplatin–etoposide) and then radiotherapy with a total dose of 70 Gy. Of the 10 cases of paraneoplastic syndrome (PNS) related to laryngeal NEC reported in the literature, nine of these syndromes were of an endocrine type. Only one case of PNS associated with laryngeal cancer had a neurological manifestation, which was LEMS. To the best of our knowledge, this current case has only one similar precedent in the literature and it is the second report of an association between a PD-NEC and LEMS. Laryngeal NECs are rare lesions with different prognostic characteristics. The diagnosis should be made using an endocrinological, neurological, radiological and histological multidisciplinary approach. A radical surgical approach is recommended.

Myasthenia-like paraneoplastic syndrome with multiple cranial nerve tumor infiltration: A case report and literature review

“…This finding is similar to the clinical features of our patient. Mesolella et al [ 26 ] also reported a patient with laryngeal neuroendocrine carcinoma who did not undergo EMG examination and did not have paraneoplastic or MG-related antibodies. LEMS was diagnosed based on typical symptoms of proximal muscle weakness and autonomic dysfunction.…”

Quality of Life and Respiratory Performance in the Laryngectomized Patient: Role of the HME Filters during Physical Activity

“…Furthermore, there is a decrease in strength and physical resistance, which leads to difficulty in carrying out strenuous activities and, in more serious cases, even simple daily activities. Concern about one’s physical appearance and one’s voice is what most affects the psychological well-being of laryngectomy patients, leading them to maintain a distance from the world around them and to withdraw into themselves, thinking that other people find them unpleasant [ 34 , 35 ].…”

Quality of Life and Respiratory Performance in the Laryngectomized Patient. Role of the Hme Filters during Physical Activity

“…Concern about one's physical appearance and one's voice is what most affects the psychological well-being of the laryngectomee patient, leading him to maintain a distance from the world around him and to withdraw into himself, thinking that other people find him unpleasant. [34,35] Consequently, although laryngeal cancer has a good cure rate, it is equally true that it disturbs the patient's psychological balance throughout his life, influencing his habits and constantly reminding him of the cancer experience, due to the permanent presence of the tracheostoma. [20,32,36] Considering this, it is correct to take note of the change in the quality of life of the laryngectomee patient, but, at the same time, also of the current therapeutic and rehabilitative supports, which allow to compensate for this handicap.…”